CDA members are typically unfamiliar with the peer review process unless they have gone through it themselves or have served on a local peer review committee. Even those who are aware of peer review might not know that the program was recently enhanced to include informal mediation. The purpose of the peer review program is to resolve disputes between patients and dentists, focusing on disputes about the quality or appropriateness of dental treatment.

The August issue of the Journal of the California Dental Association reviews the persistent problem of dental anxiety in dentistry. Articles discuss ways to communicate effectively with fearful patients, the use of virtual reality exposure therapy in treating dental anxiety, and the assessment, diagnosis and management of dental phobia in children and adults.

The July issue of the Journal of the California Dental Association highlights the importance of dental practice safety and risk management. Articles discuss the legal ramifications of practicing unsafe dentistry, the proper choice and use of emergency medications and the use of checklists to improve patient safety.

Every practice will come across a debt that needs to be sent to an agency, but such debt should be the exception to the rule. The goal should be to prevent accounts past due, not to collect on them. Start with good policy. A financial policy is pertinent to a practice’s success, and practices should have both internal and external financial policies.

Of the nearly 3,500 professional liability claims The Dentists Insurance Company addressed between 2012 and 2017, many could have been avoided or mitigated had the dentist been more cautious about choosing which patients to accept into care. “Being selective in the patients you see goes a long way in avoiding trouble down the road,” said Taiba Solaiman, senior TDIC Risk Management analyst.

The Dentists Insurance Company reports several calls to its Risk Management Advice Line from practice owners facing irate patients. Typically, these cases stem from patients who are upset over unplanned expenses, treatment plans they consider unnecessary, failure to achieve expected results from cosmetic procedures or a dentist’s refusal to practice outside the standard of care when a patient attempts to dictate treatment.

“I need more patients” is a statement I’ve heard often from dentists throughout my career. While new patients are undeniably important to a practice’s success, practice owners should be aware of opportunities they may already have within their existing patient base. According to recent research, the average dental office in America has just a 65 percent patient retention.

A new state law requires that tamper-resistant prescription forms for controlled substances have unique serial numbers. These numbers will be linked to corresponding records in California’s prescription-drug monitoring program known as CURES. The requirement is part of Assembly Bill 1753 signed into law last September. New prescription forms should be ordered from a “serial # compliant printer” as indicated on the DOJ’s website.

In a dental economy dominated by PPOs, dentists are looking for ways to encourage patients, particularly those with limited coverage or no coverage at all, to seek the care they need. According to the ADA, access to dental insurance is the No. 1 predictor of a dental visit due to the patient’s ability to offset their out-of-pocket expense for oral health care.

There is still a great misunderstanding about the spread of one of the most feared diseases in U.S. history — HIV. Unlike the flu or common cold, there is little, if any, risk of spreading the HIV virus in the dental setting as long as appropriate precautions are taken. In California, patients with HIV are protected under the Unruh Civil Rights Act, which prohibits discrimination on the basis of medical condition, race, religion, sexual orientation or disability, among other factors.

The Dentists Insurance Company’s Risk Management Advice Line recently received a call from a practice that was dealing with a case of mistaken identity for same-name patients. The caller actually represented two practices: a pediatric dentistry office and an orthodontic office, which were managed separately but shared a common patient waiting area. Two patients named Haley were scheduled for treatment at the same time — one in each office.

CDA Practice Support receives many member calls about refunding payments. Most often, these are refund requests to dental plans or patients due to quality of care and billing errors. Sometimes members ask about refund requests for treatment rendered to a recently deceased family member. The starting point for any refund request is having a comprehensive financial agreement and financial policy in place for your practice.

Spring is a prime time to deep clean your practice and tie up any loose ends from the previous year. It’s also a great opportunity to review your patient records and ensure all files are accurate and current. Here are some things to consider when revisiting patient charts. If you find something is missing, review the chart with your patient at their next visit.

The ADA on March 26 adopted a new policy to combat the opioid epidemic, calling it the potential first of its kind by a major health professional organization to support mandates on opioid prescription limits and continuing education. “I call upon dentists everywhere to double down on their efforts to prevent opioids from harming our patients and their families,” said ADA President Joseph P. Crowley, DDS, in a press release. The Interim Board Policy on Opioid Prescribing addresses continuing education, dosage and duration, and prescription and drug monitoring.

In their day-to-day practice, dentists and their teams must know and comply with federal, state and local laws — from the layered requirements of federal and state employment laws to the dentistry-specific California Dental Practice Act to local laws that enforce building codes. A first resource for dentists to help them navigate these laws is the Legal Reference Guide for California Dentists, updated and published in January by the CDA Practice Support experts.

Hiring an associate brings the opportunity to lighten workloads and potentially drive in new business. But as with any relationship, both parties may eventually agree to part ways. In worst-case scenarios, the split may not be amicable and your patients and practice as a whole may suffer unwelcome consequences.

Throughout the business week, CDA Practice Support experts answer questions submitted by members via the “Ask an Expert” feature. Staff then answer and archive the question online for the benefit of other members. But occasionally, a question or the recurrence of questions along the same theme prompts the need for a deeper probe. In one such question, a dentist expressed concern about a patient’s cognitive health — and with whom she was allowed to discuss it.

You take time to build relationships with your patients and plan long-term treatment success. But what happens when a patient has “a better idea” of what should happen midtreatment? Though many patients desire a sense of control in their dental care and want to exercise choice, the trouble happens when a patient attempts to dictate clinical decisions. TDIC has seen a recent trend in the number of patients who are requesting their restorations simply be handed over to them.

With the U.S. Department of Health and Human Services on Oct. 26 declaring the opioid crisis a public health emergency, CDA reminds dentists, who prescribe approximately 11 percent of prescription opioids annually, of the resources available to them. CDA’s online opioid resource guide at cda.org/opioid is regularly updated with links to resources as they are published.

At the recent CDA Presents The Art and Science of Dentistry convention in San Francisco, Steve Yun, MD, provided an enlightening and practical examination of dental anesthesia and patient safety in his course Myths and Errors in Dental Anesthesia: Avoiding Office Disasters. In this interview, Yun shares his top tips for enhancing patient safety during dental anesthesia.

CDA Practice Support and The Dentists Insurance Company are receiving an increasing number of calls from members on the subject of obtaining medical clearance for patients who have certain chronic conditions such as diabetes or are undergoing certain therapies. TDIC warns dentists that the medical clearance process is misleading because it implies that the patient is “cleared” for treatment.

In one handy place, CDA members can find the details, deadlines and resources they need to ensure their practice complies with upcoming laws and regulations. Check out “Are You in Compliance?” on the CDA Practice Support homepage.

A common allegation in many professional liability claims is the lack of informed consent. Patients argue that had they known about the possibility of complications, they would have made a different decision regarding their dental treatment. One of the best ways dentists can protect themselves in these cases is by ensuring patients are armed with the facts needed to make informed decisions.

In today’s dental market, patients have more choices than ever before. High expectations and an influx of information means competition is fierce, leading to a marked shift in how practice owners attract and retain patients. Long gone are the days when patients chose their dentist based on static provider directories, word-of-mouth or the Yellow Pages. Today, consumers are highly connected and able to research online reviews, ratings and guides prior to making a dental or health care choice.

Many patients suffer from dental anxiety and they all have their own ways of addressing their unease. Anxiety management techniques run the gamut, from conscious sedation to deep breathing to simply toughing it out. Sometimes patients use alcohol or drugs to relax. Whether they turn to the bottle to ease anxiety or simply enjoy a three-martini lunch, dentists are left with the uncomfortable dilemma of whether to provide treatment.

In addition to advice from experts on the business side of dentistry, CDA Practice Support provides a full online library of articles, guides, templates and tools. Check out five of the most popular resources this quarter and see how they can help make running your practice easier and more efficient.

Patient satisfaction is the ultimate goal of any dentist and most will do whatever it takes to keep their patients happy, confident and pain-free. But what happens when a patient’s expectations are unrealistic? What if a patient is impossible to please? At what point should you say “enough is enough?”

Now more than ever, patients are demanding discretionary dental treatments. Where just a few decades ago dentistry was seen primarily as an avenue to better oral health, it is now seen as a way to improve quality of life.

Emergency preparedness can sometimes mean the difference between life and death. Well-trained staff and clear emergency protocols are essential, as are regularly performed drills to ensure expediency should an emergency occur. But one of the simplest ways to prevent an emergency from becoming a tragedy is a well-stocked and up-to-date emergency kit.

Dental practice owners and office managers can feel overwhelmed by the number, purpose and complexity of reports that their practice management software generates. CDA Practice Support is responding to calls from members by offering a free one-hour lecture at CDA Presents The Art of Science and Dentistry in Anaheim to help practice owners and office managers review eight key reports to evaluate successes and identify inefficiencies within the practice.

All too often, patients fail to follow treatment recommendations due to expense, putting their oral health at risk. In addition, dentists sometimes make their treatment recommendations based on what a patient’s insurance plan will cover. The Dentists Insurance Company reports calls to the Risk Management Advice Line from dentists whose patients have refused care based on the cost. While budgetary limitations are certainly a reality of life, dentists are advised to proceed with caution when allowing patients to dictate care.

CDA has created a new online resource guide to help dentists meet requirements and follow best practices when prescribing opioids for the treatment of patients' dental pain. This resource is CDA's latest in ongoing efforts to address and combat California's opioid epidemic and ensure members have the most up-to-date information to maintain compliance in the dental practice.

Imagine taking your car to the shop for a minor repair — say, to replace the spark plugs or patch a tire. Now, imagine picking your car up at the end of the day to discover that your engine has been completely rebuilt — and you’re responsible for the bill. This scenario would be unlikely to occur in the auto repair industry, but it happens all too often in the dental industry, leaving broken trust, unhappy patients and disputed bills in its wake.

Under AB 2235, the pediatric anesthesia bill signed into law by Gov. Jerry Brown last September, dentists are required to obtain written informed consent from the parent or legal guardian of a minor patient prior to administration of general anesthesia or conscious sedation. As part of this requirement, the written informed consent form must contain new, specific language.

CURES 1.0 will be discontinued on Sunday, March 5, 2017. The departments of Consumer Affairs and Justice have announced that beginning March 6 prescribing health care practitioners will only be able to access CURES 2.0. To securely access CURES 2.0, dentists will need to update their web browsers as specified.

Collections is one of the most crucial and challenging aspects of practice management. Using a collections protocol is a basic first step in addressing unpaid balances, but if phone calls and letters go unanswered, a dentist is faced with the dilemma of whether to turn the account over to a collection agency. TDIC advises dentists to carefully consider the pros and cons of such an action.

Whether an old flame or a disloyal friend, choosing to accept someone back into one’s life can be a difficult decision. But what about accepting dismissed patients back into the practice? Do they deserve a second chance? The answer is: It depends. According to The Dentists Insurance Company, in some cases, such as noncompliance, accepting a dismissed patient back to the practice can lay the groundwork for a liability claim. But in other cases, the answer isn’t so clear.

Under the provisions of the American Recovery and Reinvestment Act, participating Denti-Cal providers may receive up to $63,750 in incentive payments for implementing an electronic health record system and eventually achieving “meaningful use.” The program will close to new registrants on Dec. 31, and any dentist who has not started in the incentive program will lose the opportunity to claim those dollars.

The ADA Council on Access, Prevention, and Interprofessional Relations recommends a free online educational program to equip oral health care professionals with the knowledge, skills and awareness to best deliver oral health services to all patients, regardless of cultural or linguistic background.

When it comes to missed opportunities in small businesses, one cannot blame small business owners if, as the saying goes, “they don’t know what they don’t know.” When the small business owner is a dentist, a couple of common areas of missed opportunity include new patient experience and retention of active patients.

The Kids’ Healthy Mouths campaign has partnered again with Scholastic to offer resources for parents to reinforce their children’s good teeth-brushing habits. Dentists can visit or direct parents to Scholastic’s Healthy Teeth webpage for a list of recommended books about brushing along with downloadable bilingual materials.

A lecture will be held at CDA Presents The Art and Science of Dentistry in San Francisco to help dentists navigate the professional responsibilities and regulatory requirements of pain management and opioid diversion.

As part of a contractual commitment the dental benefit plans have with their consumers (employer groups and their employees), the plans are required to have a claims utilization review and audit process.

The goal for most practice owners is to send out as few billing statements as possible. This goal correlates with setting strong payment and collections policies and making sure staff is adhering to those rules, according to CDA Practice Advisor Sarah Gargani.

The Centers for Medicare and Medicaid Services has extended the deadline for dentists to either enroll as a Medicare Part D "ordering/referring provider" or opt out of the Medicare program entirely. The previous deadline was June 1, but it has now been extended to Feb. 1, 2017.

CDA Practice Support is designed to help dentists navigate the business side of dentistry with ease, and it is chock-full of valuable resources to help them run their practices. Here are the top five trending CDA Practice Support resources in the categories of practice management, employment practices, dental benefit plans and regulatory compliance.

In collaboration with pharmacy colleagues, authors of the November issue of the Journal of the California Dental Association present the most current information on pain management in dentistry. This issue includes timely information relative to opioid medication regulations and abuse.

In April, Trevor Thorn, DDS, purchased his first solo practice in Sonora and within the first eight months had four of his eight employees go out on disability or maternity leave. Having little experience in handling the business side of a practice when dealing with human resources issues, Thorn picked up the phone and called CDA Practice Support to get up to speed on how to properly accommodate employees who are on disability. There are countless stories just like this of CDA members.

There are three remaining opportunities for dentists to attend the fall 2015 lineup of TDIC's Risk Management seminar, Beyond the Science: Patient Emotions in Dentistry. TDIC is offering the seminar to help dentists correctly identify and handle patients who exhibit dental fear. Beyond the Science: Patient Emotions in Dentistry presents real case studies to dentists and staff members to help them recognize when, and how, to dismiss a patient without placing them at risk; establish trust in the doctor-patient relationship to encourage treatment compliance; create office protocols to instill confidence in the dentist and staff.

Dental practices now must obtain authorization from a patient to call him or her on his or her cellphone to discuss account and insurance information, according to a recent ruling. A July 10 order by the Federal Communications Commission, interpreting a rule it promulgated in 2013, is cause for CDA to advise dental practices to ensure their policies and procedures for communications using patients’ cellphone numbers is in compliance with the law.

When new patients call a practice, it is typically with the hope of identifying their new dentist. They want someone who is confident and competent guiding them through their first appointment, explaining benefits and framing their next appointment effectively. Most likely, they are still looking for a dentist because they have not found an office that has been able to accomplish this. When it comes to communication, dentists and their staff need to be ready to confidently anticipate and manage the patient’s expectations.

In today’s market, patients have become extremely busy, and “emergency appointments” have become more common. Therefore, every dental office should design and implement their own “emergency protocol” and customize it to accommodate the changing patient landscape.

Registration for the new fall 2015 lineup of TDIC’s Risk Management seminar, Beyond the Science: Patient Emotions in Dentistry, is now open. Beyond the Science: Patient Emotions in Dentistry presents real case studies to dentists and staff members to help them recognize when, and how, to dismiss a patient without placing them at risk; establish trust in the doctor-patient relationship to encourage treatment compliance; create office protocols to instill confidence in the dentist and staff.

Each dental office should have an implementation strategy that includes a vision of how they will offer their services to diverse populations. In California, many patients enter a dental practice with Spanish being their only language, and the dentist and staff should have resources available to effectively communicate with those patients. CDA now has available a patient health history form that has been translated in Spanish for patients of a dental practice. Dental practices can print out the form and use it in their offices.

Oftentimes, a dentist will have a particular staff member or patient they just can’t seem to connect with. A certain task or treatment isn’t accepted and it can cause frustration with the dentist. While in some cases this may be a result of being confrontational and having difficulty with acceptance, it can also happen because of a generational gap.